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H H S Department of Health and Human Services
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Ryan White and Affordable Care Act Outreach, Enrollment and Benefits Counseling

This table highlights Ryan White HIV/AIDS Program service categories by Part that can be used to support outreach, benefits counseling and enrollment activities. Learn more: Dear Ryan White HIV/AIDS Program Colleagues letter (PDF - 26 KB)

Note: Not all Ryan White providers offer all of the service categories listed below. Decisions regarding use of Ryan White Part A and Part B funding for specific services are made by the jurisdiction based on needs assessment data.
 #Service CategoryAppropriate For Rationale
Ryan White Part A and Part B1

Early Intervention Services (EIS) that include identification of individuals at points of entry and access to services and provision of:
• Referral services
• Linkage to care
• Health education and literacy training that enable clients to navigate the HIV system of care
• HIV testing (with prior Project Officer approval)

(Core Medical Service)
 

⇒ Benefits Counseling
⇒ Enrollment
⇒ Outreach Education
Referrals and linkages to care may include enrollment in Medicaid, Medicare, private insurance plans through the health insurance Marketplaces/Exchanges and benefits counseling.  Services are generally provided to clients who are new to care.
2

Medical Case Management Services (including treatment adherence) to ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care, provided by trained professionals, including both medically credentialed and other health care staff who are part of the clinical care team, through all types of encounters including face-to-face, phone contact, and any other form of communication. Activities that include at least the following:
• Initial assessment of service needs
• Development of a comprehensive, individualized care plan
• Coordination of services required to implement the plan
• Continuous client monitoring to assess the efficacy of the plan
• Periodic re-evaluation and adaptation of the plan at least every 6 months, or more frequently, as necessary.

(Core Medical Service)
 

⇒ Benefits Counseling
⇒ Enrollment
Medical Case Management includes a range of client-centered services that link clients with health care, psychosocial, and other services. This may include benefits/entitlement counseling and referral activities to assist clients with access to other public and private programs for which they may be eligible (e.g., Medicaid, Marketplaces/Exchanges, Medicare Part D, State Pharmacy Assistance Programs, and other State or local health care and supportive services).  It will depend on the local structure of the medical case management model. Services are provided to prevent clients from falling out of care.
Ryan White Part A and Part B3

Case Management (Non-medical) services that provide advice and assistance to clients in obtaining medical, social, community, legal, financial, and other needed services
• Benefits/entitlement counseling and referral activities to assist eligible clients to obtain access to public and private programs for which they may eligible
• All types of case management encounters and communications (face-to-face, telephone contact, other)
• Transitional case management for incarcerated persons as they prepare to exit the correctional system

(Support Service)
 

⇒ Benefits Counseling
⇒ Enrollment 
The service definition includes benefits/entitlement counseling and referral activities as allowable activities.  Services are provided to prevent clients from falling out of care.
4

Health Education/Risk Reduction services that educate clients living with HIV about HIV transmission and how to reduce the risk of HIV transmission
• Provision of information about available medical and psychosocial support services
• Counseling on how to improve their health status and reduce the risk of HIV transmission to others

(Support Service)
 

⇒ Outreach EducationPLWHA who are aware of their status and not in care often cite lack of awareness of health resources. Entry into care is a prevention and risk reduction tool, thus education of clients with regard to the Affordable Care Act and other resources available to them as a key component of health education and risk reduction should occur. Services can be provided to clients who are not in care or who have fallen out of care.
5

Outreach Services designed to identify individuals who do not know their HIV status and/or individuals who know their status and are not in care and help them to learn their status and enter care

(Support Service)
 

⇒ Outreach EducationOutreach services can provide additional information on the Affordable Care Act benefits and help clients learn of their status and enter care.  Services are generally provided to clients who are not aware of their status and/or not in care.
Ryan White Part A and Part B6

Referral for Health Care/Supportive Services that direct a client to a service in person or through telephone, written, or other types of communication, including the management of such services where they are not provided as part of Ambulatory/Outpatient Medical Care or Case Management Services
May include: 
benefits/entitlement counseling and referral to refer or assist eligible clients to obtain access to other public and private programs for which they may be eligible, e.g., Medicaid, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturers’ Patient Assistance Programs, and other State or local health care and supportive services
Referrals may be made:
• Within the Non-medical Case Management system by professional case managers
• Informally through community health workers or support staff
• As part of an outreach program

(Support Service)
 

⇒ Benefits Counseling
⇒ Enrollment
⇒ Outreach Education
This service specifically mentions benefits/entitlement counseling and referral to refer or assist eligible clients to obtain access to other public and private programs. It supports retention, adherence to services and assists in clients navigating through available resources. Services are generally provided to clients who have a change in insurance status, new eligibility, or require a change in treatment regimen.
Ryan White Minority AIDS Initiative Part B7The overall goal of the Ryan White Part B MAI program is to improve minority access to HIV/AIDS medications to treat HIV/AIDS and prevent opportunistic infection through the Part B ADAP and as appropriate to other programs providing prescription drug coverage. ⇒ Benefits Counseling
⇒ Enrollment
⇒ Outreach Education
This service is specifically designed to increase access to medication programs which include Medicaid, Medicare, private insurance through the health insurance Marketplaces/Exchanges and benefits counseling.  Services are generally provided to minority clients.
Ryan White Part C8

Medical Case Management including a range of patient-centered services that result in a coordinated care plan, which links patients to medical care, psychosocial, and other services including treatment adherence services.

(Core Medical Service)

⇒ Benefits Counseling
⇒ Enrollment
Medical Case Management includes a range of client-centered services that link clients with health care, psychosocial, and other services.  This may include benefits/entitlement counseling and referral activities assisting clients to access other public and private programs for which they may be eligible (e.g., Medicaid, Marketplaces/Exchanges, Medicare Part D, State Pharmacy Assistance Programs, and other State or local health care and supportive services).  It will depend on the local structure of the medical case management model.  In some cases this may be done by eligibility specialist or benefits advocates.  Services are provided to prevent clients from falling out of care.
9

Case Management (Non-medical) services that provide advice and assistance to clients in obtaining medical, social, community, legal, financial, and other needed services
May include: Benefits/entitlement counseling and referral activities to assist eligible clients to obtain access to public and private programs for which they may eligible

(Support Service)
 

⇒ Benefits Counseling
⇒ Enrollment
This service definition includes benefits/entitlement counseling and referral activities as allowable activities.  Services are provided to prevent clients from falling out of care.
10

Outreach to identify people with HIV, or at-risk of contracting HIV, to educate them about the benefits of early intervention and link them into primary care

(Support Service)
 

⇒ Outreach
⇒ Enrollment
Outreach services can provide additional information on the Affordable Care Act benefits and help clients learn of their status and enter care.  Services are generally provided to clients who are not aware of their status and/or not in care.
Ryan White Part D11

Medical Case Management Services (including treatment adherence) to ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care, provided by trained professionals, including both medically credentialed and other health care staff who are part of the clinical care team, through all types of encounters including face-to-face, phone contact, and any other form of communication. Activities that include at least the following:
• Initial assessment of service needs
• Development of a comprehensive, individualized care plan
• Coordination of services required to implement the plan
• Continuous client monitoring to assess the efficacy of the plan
• Periodic re-evaluation and adaptation of the plan at least every 6 months, or more frequently, as necessary

(Core Medical Service)

 

⇒ Benefits Counseling
⇒ Enrollment
Medical Case Management includes a range of client-centered services that link clients with health care, psychosocial, and other services.  This may include benefits/entitlement counseling and referral activities to assist clients with to access to other public and private programs for which they may be eligible (e.g., Medicaid, Marketplaces/Exchanges, Medicare Part D, State Pharmacy Assistance Programs, and other State or local health care and supportive services).  It will depend on the local structure of the medical case management model.  In some cases this may be left to eligibility specialist or benefits advocates.  Services are provided to prevent clients from falling out of care.
12

Case Management (Non-Medical) services are defined as those services which are needed for individuals with HIV/AIDS to achieve their HIV medical outcomes. Case management which, includes medical, non-medical, and family-centered services.
May include:
• Financial assessment/eligibility counselors (staff whose role is to determine client eligibility for Medicaid and other insurance programs and assist them to apply).
• Staff assists clients with linkage, engagement, and retention in HIV care.

(Support Service)

⇒ Outreach Education
⇒ Enrollment
This service includes patient and family centered benefits/entitlement counseling and referral activities are allowable as part of this service under Ryan White Part D. Services are provided to prevent clients from falling out of care.